Muscle Cramping - Causes Prevention & Treatment
for Muscle Cramps
What Are Muscle Cramps?
we use the muscles that can voluntarily be controlled, such as those
of our arms and legs, they alternately contract and relax as we
move our limbs. Muscles that support our head, neck, and trunk contract
similarly in a synchronized fashion to maintain our posture. A muscle
that involuntarily contracts is called a "spasm." If the
spasm is forceful and sustained, it becomes a cramp. A muscle cramp
is thus defined as an involuntarily and forcibly contracted muscle
that does not relax. This causes an obvious hardening of the involved
Muscle cramps can last anywhere from a few seconds to several minutes
or occasionally longer. It is not uncommon for a cramp to recur
multiple times until it finally goes away. The cramp may involve
a part of a muscle, the entire muscle, or several muscles that usually
act together. Some cramps involve the simultaneous contraction of
muscles that ordinarily move body parts in opposite directions.
Cramps are extremely common. Almost everyone experiences a cramp
at some time in their life. Cramps are common in adults and become
increasingly frequent with aging. However, children can also experience
Any of the muscles that are under our voluntary control (skeletal
muscles) can cramp. Cramps of the extremities, especially the legs
and feet, and most particularly the calf (the classic "charley
horse"), are very common.
What Are The Types and Causes of Muscle Cramps?
muscle cramps can be categorized into four major types. These include
"true" cramps, tetany, contractures, and dystonic cramps.
Cramps are categorized according to their different causes and the
muscle groups they affect.
"True" cramps involve part or all of a single muscle or
a group of muscles that generally act together, such as the muscles
that flex several adjacent fingers. "True" cramps are
caused by hyper-excitability of the nerves that stimulate the muscles.
They are the most common type of skeletal muscle cramps. "True"
cramps can occur for a number of reasons, such as:
Injury: Persistent muscle spasm may occur as a protective
mechanism following an injury. Injury of the muscle alone may cause
the muscle to spasm.
Vigorous activity: "True" cramps are commonly
associated with the vigorous use of muscles and muscle fatigue.
These cramps may come during the activity or even hours later. Likewise,
muscle fatigue from sitting or lying for an extended period in an
awkward position, or any repetitive use can cause cramps. Older
adults are more at risk for these types of cramps when performing
vigorous or strenuous physical activities.
Rest cramps: Cramps at rest are also very common, and can
be experienced at any age, including childhood. Rest cramps often
occur during the night. While not life-threatening, night cramps
can be painful, disruptive of sleep, and they can recur frequently.
The actual cause of night cramps is unknown. Sometimes, such cramps
are initiated by making a movement that shortens the muscle. A common
example is stretching the toe down while lying in bed, which shortens
the calf muscle, causing cramps.
Dehydration: Sports and other vigorous activities can cause
excessive fluid loss from perspiration. This kind of dehydration
increases the likelihood of "true" cramps. These cramps
are more likely in warm weather and can be an early sign of heat
stroke. Sodium depletion has also been associated with cramps. Loss
of sodium, the most abundant chemical constituent of body fluids
outside the cell, is usually a function of dehydration.
Low blood calcium, magnesium: Low blood levels of either
calcium or magnesium directly increase the excitability of both
the nerve endings and the muscles they stimulate. This may be a
predisposing factor for the spontaneous "true" cramps
experienced by many older adults, as well as for those that are
commonly noted during pregnancy.
Cramps are seen in any circumstance that decreases the availability
of calcium or magnesium in body fluids, such as from diuretics,
hyperventilation, excessive vomiting, inadequate calcium and/or
magnesium in the diet, inadequate calcium absorption due to vitamin
D deficiency, poor function of the parathyroid gland, and other
Low potassium: Low potassium levels occasionally cause muscle
cramps, although it is more common for low potassium to be associated
with muscle weakness.
tetany, all of the nerve cells in the body are activated, which
then stimulate the muscles. This reaction causes spasms or cramps
throughout the body. The name tetany is derived from the effect
of the tetanus toxin on the nerves. However, the name is now commonly
applied to muscle cramping from other conditions, such as low blood
levels of calcium and magnesium.
Sometimes, tetanic cramps are indistinguishable from "true"
cramps. The accompanying changes of sensation or other nerve functions
that occurs with tetany may not be apparent because the cramp pain
is masking or distracting from it.
Contractures result when the muscles are unable to relax. The constant
spasms are caused by a depletion of (ATP), an energy chemical within
the cell. This prevents muscle fiber relaxation. The nerves are
inactive in this form of muscle spasm. Cramps of this category are
The final category is dystonic cramps, in which muscles that are
not needed for the intended movement are stimulated to contract.
Muscles that are affected by this type of cramping include those
that ordinarily work in the opposite direction of the intended movement,
and/or others that exaggerate the movement.
Some dystonic cramps usually affect small groups of muscles like
the eyelids, jaws, neck, etc. The hands and arms may be affected
during the performance of repetitive activities such as those associated
with handwriting (writer's cramp), typing, playing certain musical
instruments, and many others. Each of these repetitive activities
may also produce "true" cramps from muscle fatigue. Dystonic
cramps are not as common as "true" cramps.
Other Causes of Cramps
Numerous medicines and certain disease processes can also cause
cramps. Potent diuretic medications can induce cramps by depleting
body fluid and sodium. Simultaneously, diuretics often cause the
loss of potassium, calcium, and magnesium, which can also cause
Numerous medications have caused cramps as a major side-effect
or interaction. Some medicines used to lower cholesterol can also
lead to cramps.
Cramps are sometimes noted in addicted individuals during withdrawal
from medications and substances that have sedative effects, including
alcohol, barbiturates and other sedatives. Anti-anxiety agents such
as Valium and Xanax, narcotics, and other drugs can also produce
Can Vitamin Deficiencies Cause Muscle Cramps?
Several vitamin deficiency states may directly or indirectly lead
to muscle cramps. These include deficiencies of thiamine (B1), pantothenic
acid (B5), and pyridoxine (B6). The actual mechanism in causing
cramps is unknown.
Can Poor Circulation Cause Muscle Cramps?
Poor circulation to the legs, which results in inadequate oxygen
to the muscle tissue, can cause severe pain in the muscle. This
commonly occurs in the calf muscles. This pain may be due to accumulation
of lactic acid and other chemicals in the muscle tissues. It's important
to see your doctor if you have pain like this.
What Are The Symptoms of Common Muscle Cramps? How Are They
There are no special tests for cramps. Most people know what cramps
are and when they have one. If present during a cramp, the doctor,
or any other bystander, can feel the tense, firm bulge of the cramped
Usually a cramp is painful, often severely so. Often, the individual
experiencing the cramp must stop whatever activity is under way
and seek relief. The person is unable to use the affected muscle
while it is cramping. Severe cramps may also be associated with
soreness and swelling, which can occasionally persist up to several
days after the cramp has subsided.
What Is The Treatment of skeletal Muscle Cramps?
cramps can be stopped if the muscle can be gently stretched. For
many cramps of the feet and legs, this stretching can often be accomplished
by standing up and walking around.
For a calf muscle cramp, the person can stand about two to two
and a half feet from a wall and lean into the wall to place the
forearms against the wall with the knees and back straight and the
heels in contact with the floor. Another technique involves flexing
the ankle by pulling the toes up toward the head while still lying
in bed with the leg as straight as possible. For writer's cramp
pressing the hand on a wall with the fingers facing down will stretch
the cramping finger flexor muscles.
Gently massaging the muscle will often help it to relax, as will
applying warmth from a heating pad or hot soak. If the cramp is
associated with fluid loss, as is often the case with vigorous physical
activity, fluid and electrolyte (especially sodium and potassium)
replacement is essential.
Medicines are not generally needed to treat an ordinary cramp that
is active since most cramps subside spontaneously before enough
medicine would be absorbed to even have an effect.
The treatment of cramps that are associated with specific medical
conditions generally focuses on treating the underlying condition.
If cramps are severe, frequent, persistent, respond poorly to simple
treatments, or are not associated with an obvious cause, then the
patient and the doctor need to consider the possibility that more
intensive treatment is indicated or that the cramps are a manifestation
of another disease. Cramps are inevitable, but if possible, it would
be best to prevent them.
Although cramps can be a great nuisance, they are a benign condition.
Their importance is limited to the discomfort and inconvenience
they cause, or to the diseases associated with them. Careful attention
to the preceding recommendations will greatly diminish the problem
of cramps for most individuals. Those with persistent or severe
muscle cramps should seek medical attention.
Richard A. DiCenso